Baby-Friendly Basics

Michigan lags behind the nation in breast-feeding rates, but two regional hospitals are working to increase the numbers.

By Dorothy Hernandez

Published: September 22, 2014

Dr. Paula Schreck

Photograph by Josh Scott

When actress Olivia Wilde, clad in couture, posed in Glamour magazine breast-feeding her son, she made it look easy and chic. But it is anything but easy and it’s far from glamorous. Just ask Christina Partalis of St. Clair Shores.

“We thought it would be … super easy and just natural. The baby comes to you, and it’s a perfect story,” says the Spanish teacher who gave birth to Gabriella this year.

But Gabriella wasn’t exactly cooperating. There were times Partalis wanted to quit, but her nurses at Beaumont Hospital in Grosse Pointe kept her going.

“They kept coming back (into her room) and helping the baby come to me, helping the baby latch — that was one of the biggest problems. There were times I just wanted to give up and just give her formula.”

Then when Partalis went home, she faced more challenges, namely nipple pain and constant feedings. She says Patricia Ashley, a registered nurse and her lactation consultant, told her to “consider the first month as one long feeding with breaks in between.” That first month, Ashley says, a baby will eat 8-12 times a day.

But it eventually got easier, Partalis says. And one thing that really made her proud was when she went to the pediatrician, who said baby Gabriella was “gaining weight like a champ.”

“That made me feel really good that it was all my breast milk,” Partalis says.

There are still issues, such as she’s limited in going out, restricted by 2-3-hour intervals when it’s time for Gabriella to eat. And she still hasn’t breast-fed in public.

Still, she plans on doing the recommended six months of exclusive breast-feeding and then the full year of breast-feeding after solids are introduced.

The help she received at Beaumont Hospital was so crucial in those first few months that if it weren’t for the nurses, she would’ve stopped, she says.

Beaumont Hospital in Grosse Pointe, which averages 70 deliveries a month, was the first hospital in southeast Michigan to be designated Baby-Friendly by the national authority for the Baby-Friendly Hospital Initiative, Baby-Friendly, USA.

Detroit hospital St. John recently joined Beaumont, attaining the status in July, becoming the second health care facility in the region to be designated Baby-Friendly.

Through services such as support groups and prenatal education as well as adopting policies to facilitate mother-baby bonding, these two hospitals are advocating for higher breast-feeding rates among area moms.

Being Baby-Friendly

The Baby-Friendly designation recognizes hospital and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. According to the accrediting organization, 195 U.S. hospitals and birthing centers in 45 states and the District of Columbia were Baby-Friendly as of press time.

Attaining Baby-Friendly status requires health care facilities to implement “Ten Steps to Successful Breast Feeding,” which includes offering services such as education and support groups as well as giving infants no food or drink other than breast milk, unless medically necessary.

In general, the percentage of infants in the United States who were ever breast-fed increased from 60 percent among infants born in 1993-94 to 77 percent among infants born in 2005-06, according to the Centers for Disease Control and Prevention.

And it’s still on the upswing. According to the CDC’s Breastfeeding Report Card 2014, 79 percent of newborns started to breast-feed. However, breast-feeding didn’t continue for the recommended time — 49 percent were breast-feeding at six months and 27 percent at 12 months.

In Michigan, the rates lag the nation’s. Seventy-five percent of babies start to breast-feed, with 46.6 percent being breast-fed at six months and then 23 percent at 12 months.

The rate is even lower in Detroit, according to Dr. Paula Schreck, who is the medical director of Breastfeeding Support Services at St. John Hospital & Medical Center and an International Board Certified Lactation Consultant. She says it was important for St. John, as a hospital in Detroit, to attain the Baby-Friendly status. The hospital already had the Outpatient Breastfeeding Clinic, which Schreck says was the first physician-led clinic in the state that addressed issues that arose after discharge. But it didn’t lead to longer breast-feeding.

“Medical research indicates the most important predictor of breast-feeding success is the hospital environment in which mothers deliver their babies,” Schreck says.

Race, Income, and Mortality

Ironically, despite formula costing thousands of dollars a year, lower-income women tend to breast-feed less. Breast-feeding rates in 1999-2006 were significantly higher among those with higher income (74 percent) compared with those who were lower income (57 percent), according to the CDC. There’s also a racial and economic disparity when it comes to breast-feeding, Schreck says, noting the African-American population had a 40 percent initiation rate compared to 75-80 percent among whites.

Detroit also “suffers from an inexcusably high rate of infant mortality,” she says. “If we bring breast-feeding to this community then we can start to move that needle because breast-feeding decreases infant mortality complications of prematurity, SIDS (Sudden Infant Death Syndrome), pneumonia, gastrointestinal problems — these all contribute to the high infant mortality rate.”

Detroit moms face several barriers, Schreck says. For example, a birthing class at St. John costs about $80, which can be a financial challenge. “Women at greatest risk are sometimes hardest to engage because of barriers” especially transportation, she adds.

St. John works closely with community partners such as Black Mothers’ Breastfeeding Association and Infant Mortality Project to address some of the barriers.

The local hospitals that are Baby-Friendly see higher breast-feeding rates. At Beaumont in Grosse Pointe, the rate averages 84 percent, with the exclusive rate at 88 percent, according to Ashley.St. John works closely with community partners such as Black Mothers’ Breastfeeding Association and Infant Mortality Project to address some of the barriers.

At St. John, the overall breast-feeding initiation rate for the entire hospital went from 55 percent in 2011 (before the Baby-Friendly improvements) to 80 percent in June of this year (after the improvements were in place), according to Schreck.

Of the 3,500 mothers who deliver annually at St. John, 1,100 are served by the resident OB clinic that serves primarily African-American mothers (83 percent) and those on Medicaid (89.9 percent). The clinic group had a 51 percent breast-feeding initiation rate before the introduction of prenatal education. This year, the initiation rate rose to 68.5 percent; additionally if they attend the Mother Nurture support group, the continuation rate doubles from 3.5 months to 7.2 months, according to Schreck, who stresses the importance of education.

St. John offers six lessons, which are given by peer counselors to women waiting to see their doctor. Topics covered include skin to skin, which is placing the baby on the mother’s chest right after birth to facilitate bonding; rooming in, where the mom and baby stay together instead of the baby going to a night nursing center; the benefits for mom and baby; using only breast milk; how to get the baby to latch on; and feeding the baby on cue, meaning a baby will eat when he or she is ready to eat for as long as he or she wants, regardless of the last feeding time.

Support from peers is also important. At St. John, their Mother Nurture Group is more like a family, says mom and group member Deanna Marshall.

Group leader Monica Washington, a single mom herself, says they keep each other from giving up, a common pitfall for nursing moms.

The group does another thing: Dispel myths regarding breast-feeding. Marshall says she was hesitant about breast-feeding at first because she thought it was “sexual.” When asked where she got that perception, she paused thoughtfully and replied:

“The world.” But after coming to the group, she felt more comfortable. And it makes sense to her. If the baby is hungry, there is an “all you can eat buffet” at the ready, she says.

Baby Food for Thought

Aside from being “optimal nutrition designed for a human,” breast milk offers many benefits for a baby, Schreck says, such as immunological factors that prime a baby’s immune system.

With the breast milk’s antibodies, even if a baby is breast-fed once, the immune system is enhanced. Breast milk also decreases the entrance of pathogens through the GI tract.

Schreck adds breast-feeding helps protect against obesity, and in turn against type 2 diabetes and hypertension later in life.

Ashley says breast-feeding protects the mom as well, citing a reduced chance of cancers such as breast and ovarian. There are also studies that moms have reduced incidence of post-partum depression, and breast-feeding can help protect against osteoporosis.

Formula has also been a topic of debate.

“Before the ’50s babies were just breast-fed,” Ashley says. Formula was “more of a status symbol. You could afford to feed your baby the modern way by giving your baby formula. … Those moms say ‘I want to do that … I can afford to purchase this for my baby.’”

There has also been much advertising by formula companies. Ashley noted a recent gimmick by a company to market a formula “produced for breast-feeding babies,” making parents think “I’m supposed to buy this.”

Part of being Baby-Friendly is to not give out free diaper bags that include free formula. Companies will also send coupons and certificates for formula.

“That’s a subtle, subconscious [message], ‘I know you’re going to breast-feed but use this formula when you need it,’” Ashley says.

For Schreck, changing the culture is a goal.

“We’re committed to making this city healthier, not just the people in the walls of my hospital but we start here and then disseminate our experience,” Schreck says.

“It’s an amazing experience to provide all what a human being needs to grow,” she says.

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